Treatment Planning in Psychology: How to Work with Complex Presentations
- Amanda Moses Psychology
- Sep 19
- 3 min read
Treatment planning is one of those clinical skills that looks tidy in textbooks but gets messy in real life. Most frameworks assume the client is presenting with a single diagnosis where we can develop clear goals and expect linear progress. But as psychologists know, real clients rarely arrive with just one neat problem.
What do you do when your client presents with overlapping diagnoses, a trauma history, executive dysfunction, and maybe some burnout too? How do you write a treatment plan that is realistic, flexible, and genuinely useful?
Let’s break it down.
Step One: Start With Formulation and Priority-Based Goals
When multiple diagnoses are on the table, treatment planning can quickly become overwhelming. Instead of trying to map out everything, come back to formulation. Ask yourself:
What is getting in the way of this client moving forward?
What does the client want to be doing—but currently can’t?
What would improvement look like for them in daily life, not just symptom terms?
What is maintaining the problem? (Think both personal and systemic factors.)
From there, identify priority-based goals:
What are the most accessible issues to start with?
Where does the client want to begin?
What is having the biggest impact on functioning and wellbeing right now?
This shifts the plan towards an integrated roadmap that actually helps.
Step Two: Treatment Planning with Comorbidity
Comorbidity doesn’t mean “two separate problems.” Conditions often interact in complex ways:
Emotional dysregulation may be tied to both trauma and autistic sensory overload
Avoidance might stem from anxiety and executive functioning difficulties
Sleep problems may involve hyperarousal layered with poor routine scaffolding
Your treatment plan should reflect these overlaps by focusing on shared maintaining factors rather than siloed interventions. For example:
Emotional regulation and safety strategies
Executive functioning supports
Identity and self-concept work
Interpersonal boundaries and communication
This avoids duplicated or conflicting goals and makes the plan more coherent for both therapist and client.
Step Three: Flexible Therapy Goals for Complex Clients
Clients with complex presentations are often exhausted by systems that expect them to “try harder.” Your plan should not replicate that.
Set goals that are flexible and meet the client where they are. For example:
Explore one strategy to reduce shutdown triggers before work
Trial one new self-care routine that takes just ten minutes per day
Try one new support or accommodation for managing life admin tasks this week
These micro-goals don’t water down therapy—they make it more accessible and achievable.
Step Four: Let the Plan Evolve With the Client
Treatment plans rely on evolving formulations, they are not static. As therapy unfolds:
Clients grow and change
New challenges emerge
Safety and connection may lead clients to disclose more over time
Expect to revisit and adapt the plan as therapy progresses. If a goal isn’t working, or your client isn't progressing as expected, take that as an opportunity to reflect on your formulation and what is keeping the client stuck.
Final Thoughts
There is no “perfect” treatment plan for a client with a complex presentation. But there are better ways to do it—ways that honour complexity, reduce overwhelm, and reflect the reality of human distress.
The most effective treatment plans are:
Collaborative: built with the client, not for them
Flexible: able to evolve as therapy progresses
Meaningful: centred around what truly matters to the client, not just what fits a manual
When we approach treatment planning this way, we move from ticking boxes to creating living documents that actually guide effective, compassionate care.
Want to Take This Further?
If this blog resonated with you, here are two resources that will deepen your skills in treatment planning and working with complexity:
This self-paced training gives you clear, evidence-informed strategies to tease apart overlapping conditions. It’s designed for clinicians who are navigating comorbidity, diagnostic uncertainty, and nuanced presentations—so you can move from confusion to clarity and ensure your treatment planning is accurate and clinically sound.
👉 Learn more about the Differential Diagnosis Training →
If treatment planning often feels overwhelming, this structured resource will help you turn assessment data into a working formulation and treatment plan. It gives you a framework to simplify complexity, while still allowing the flexibility clients with multiple diagnoses and trauma histories need.
👉 Explore the Case Formulation & Treatment Planning Resource →
